Referral to. Against. Sponsor: Children 2011) DATA SET. standard. September Summary: return to: Referral to. Page. 1 of 29

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1 WELSH INFORMATION STANDA ARDS BOARD DSC Notice: DSCN - 07 Date of Issue: 14 th Ministerial / Official Letter: Referral to Treatmentt (RTT) Guidance (Richard Bowen, 14 th ) Subject: The introduction of the Referral to Treatment Times (Combined) return Delivering Improved Compliance Against Waiting Time Standards (Paul Williams, 25 th October 2010) Sponsor: Richard Bowen Director of Operations Department for Health, Social Services & Children Welsh Government Implementation Date: October submissions (for data relating to ) DATA SET CHANGE NOTICE A Data Set Change Notice (DSCN) is an information mandate for a new or revised information standard. This DSCN was approved by the Welsh Information Standards Board (WISB) on the 5th WIGSB Reference: IGRN / 020 Summary: To introduce the Referral to Treatment Times (RTT) (Combined) return to: Include the main Referral to Treatment Times; Include the Cardiac Referral to Treatment Times; Include a sub set of the Diagnostic & Therapy Waiting Times; Introduce the data item Stage of Pathway ; Formalise a change to the submission date. Data setss / returns affected: Referral to Treatmentt Times Cardiac Referral to Treatment Times Please address enquiries about this Data Set Change Notice to the Data Standards Team in NHS Wales Informatics Service: 1 of 29

2 / Tel: /2540 The Welsh Information Standards Board is responsible for appraising information standards. Submission documents and WISB Outcomes relating to the approval of this standard can be found at: cfm?orgid= =742&pid= of 29

3 DATA SET CHANGE NOTICE Introduction In November 2006, Welsh NHS Trusts were instructed to supply information on Cardiac Total Waiting Times in order to support the Service and Financial Framework (SaFF). These have subsequently been used to monitor a series of Annual Operating Framework (AOF) targets. The targets specified that all patients referred by a GP or other medical practitioner to adult secondary or tertiary cardiology would receive definitive treatment within 32 weeks of receipt of the original referral by the receiving Trust. Trusts were required to submit their Cardiac RTT return to the Business Service Centre Information Department (now part of the NWIS) no later than 20 days after the end of the reporting period. The RTTT information flow ( main RTT) was introduced in April 2007 to assist in monitoring the Welsh Assembly s commitment thatt no patientt in Wales would wait more than 26 weeks from GP referral to treatment. The RTTT return has previously been submitted to the NHS Wales Informatics Services ( NWIS) on the 25 th calendar day of every month by Welsh Local Health Board (LHBs) / Trusts. In January, it was informally agreed to bring forward the submission date of this return to 10th working day each month. The collection of Diagnostic & Therapy waiting times reporting was originally introduced in April This covers all waiting times for a specific range of Diagnostics and Therapy servicess at any stage in a patient s care pathway. These have historically been excluded from the main RTT return and have only been reported separately. In its role of working with LHBs in ensuring achievement of RTT targets, the Delivery & Support Unit (DSU) has collected additional data, including the stage of pathway that patients were on at the time of the monthly census. The changes to the RTT returns described in this DSCN relatee to combining the main RTT and Cardiac RTT returns, adding a subset of the Diagnostic & Therapy Waiting Times and adding Stage of Pathway into a single monthly RTT (Combined) return. The rules applying to clock starts and clock stops for the main and Cardiac RTT returns have been different since their inception. For instance, a patient transferring to a different provider for a continuation of their wait for treatment would have their clock stopped and restarted for Main RTT but the clock would continue for the Cardiac RTTT until eventual commencement of treatment, whereverr that occurred. These differing business rules remain unchanged. Historically, RTTT has been focussed on capturing waiting times in respect of referrals to consultants only. However, the introduction of a subset of the Diagnostic & Therapy Waiting Times means that this business rule has now changed, as referrals to other non-consultant clinical staff are now in scope of the combined return. The original RTT guidance (WHC (2006) 081) specifically advised that non-consultant referrals for a diagnostic or Allied Health Professional (AHP) intervention, which preceded the consultant referral, were out of scope and, as such, should not be included within the reported referral to treatment times. However, as advised in Paul Williams letter dated 25 th October 2010, waits for a diagnostic or AHP intervention with a source of referral other than a consultant that initiate a new pathway are now to be included when reporting Referral to Treatment Times. The Diagnostic and Therapies Waiting Times return is unaffected by these changes. Historically, Referral to Treatment Times have been reported using Main Specialty (of Consultant) to identify the consultant care for which a patient is awaiting treatment. However, due to the changing management of referrals in secondary care, such as the use of 3 of 29

4 pooled specialty waiting lists and the fact that referrals are now often directed to a specialty or service rather than a named individual, this is no longer appropriate. Therefore, in the new RTT (Combined) return, the data item Treatment Function Code is to be used to capture the specialty under which a patient is currently being treated or is waiting to be treated. The data item Local Sub Specialty is also to be included initially in the new return in order to distinguish between adult and paediatric cardiology referral to treatment times. NWIS ( Mold office) currently receives monthly patient-level data covering Welsh residents treated in England from a range of English NHS organisationss for the purposes of reporting main and Cardiac RTT. Arrangements for the provision of this data have been agreed between the DSU and individual English NHS organisations. The patient-level dataa is reformatted by NWIS into two aggregate returns the main RTT and Cardiac RTTT returns. The new RTT (Combined) data return will be submitted via the NHS Wales Data Switching Service (NWDSS) 1, with associated dataa quality checking taking place using the Validation at Source Service (VASS) 2. Both of these systems are developed and maintained by NWIS. Description of Change To combine the reporting of main and Cardiac Referral to Treatment Times, to include waits for a subset of the Diagnostic & Therapy Waiting Times and to add the data item Stage of Pathway. The new combined return will include the data items: o Referring Organisation Code Previously reported in the Cardiac RTT return but not in the main return. o Stage of Pathway An entirely new data item (seee further comments below). o Treatment Function Code Replaces the data item Main Specialty (of Consultant). The definition of Treatment Function Code now includes a significant amount of additional information associated to reflect the requirement to report RTT waits for diagnostic (998) and Allied Health Professional (AHP) (999) services in the new RTT (Combined) return. The new data submission timescales (i.e. report by 5pm on the 10 th working day of each month) are formalised via this DSCN. Timescales associated with the provision of a data return for Welsh residents treated (or waiting for treatment) in English PCTs are specified. Service Delivery & Performance Division have confirmed that there is no requirement for LHBs to report waits for English residents treated (or waiting for treatment) in Welsh LHBs / Trusts. Scope of Return The new RTT (Combined) return now includes: All waits previously reported within the main RTT return; 1 NwdssMerge/default.aspx 2 NwdssMerge/VASS/ 4 of 29

5 All o waits previously reported within the cardiac RTT return; Both of these will already include patients on a pathway but awaiting a diagnostic or AHP service intervention or result. All waits for pre-consultant referrals (e.g. referrals from a GP) to diagnostic and AHP services, as largely included in the monthly Diagnostic and Therapies (DaTs) return i.e. the following Diagnostic / AHP services are to be excluded: o Arts Therapies; o Occupational Therapy Learning Difficulties / Mental Health; o Speech & Language Learning Difficulties / Mental Health. All waits associated with referrals to an AHP service from a consultant specialty where clinical responsibility for the patientt has been transferred to the AHP service. Waits associated with Mental Health specialties remain out of scope for the RTT (Combined) return. Stage of Pathway Pre-existing definitions of Stage of Pathway were found not to be mutually exclusive and lacked clarity in respect of diagnostic intervention waits be that admitted or pre- consultant. Historically, 5 stages have been collected via the DSU Stage of Pathway return, the 4 th and 5 th stagess aimed to distinguish between patients waiting for diagnostic admissions and therapeutic admissions. This distinction is often not known (e.g. endoscopy activity) ), therefore a single stage of pathway waiting for an admitted diagnostic OR therapeutic intervention - has been proposed. Data Dictionary Version This DSCN will be reflected in version 3.4 of the NHS Wales Data Dictionary. Actions Required Actions for Local Health Boards / Trusts: From October, submit and sign off monthly, the RTT (Combined) return to NWIS by 17:00 on the 10 th working day of the month in accordance with the instructions set out in this DSCN. The first submission of the new return ( data) is due by Friday 14 th October. Retrospective corrections to submitted dataa are routinely permissible via the submission of a separate data return for the month proceeding the current reporting month only. Discontinue the submission of separate monthly main and Cardiac RTT to NWIS / Health Statistics & Analysis Unit and the Stage of Pathway report to DSU. Continue to submit the monthly Diagnostic & Therapies Waiting Times return. Actions for the NHS Wales Informatics Service (NWIS): 5 of 29

6 Update the NHS Wales Data Switching Services (NWDSS) and relevant infrastructure to enable the collection, storage, onward distribution and analysis of the RTT (Combined) data return. Update Validation at Source Service (VASS) 3 to allow for the submission of the RTT (Combined) return, to include the introduction of new data validity checks for the data items referring organisation code and stage of pathway. Continue to receive and process RTT data provided by NHS England organisations. Patient-level data provided to NWIS should be re-formatted into the agreed file structure and formally submitted via the NWDSS by 17:00 on the 10 th working day of the month in accordance with the instructions set out in this DSCN. Submit monthly rolling two-month extracts of RTT data to the Health Statistics & Analysis Unit, Welsh Government by the 12 th working day of the month. Actions for the Health Statistics & Analysis Unit, Welsh Government: Update data collection and validation systems to allow for the publication of RTT (Combined) data in the new format. 3 NwdssMerge/VASS/ 6 of 29

7 Appendix A: Table reflecting areas that are impacted this DSCN as a result of The following table shows all the data sets, data items, terms and other associated areas that are linked with the changes documented within this DSCN. Each data definition type is listed in alphabetical order and is shown in the sequence in whichh it appears in this DSCN. Data Definition Type Aggregate Data Set Aggregate Data Set Aggregate Data Set Aggregate Data Set Aggregate Data Set Aggregate Data Set Name Cardiac Referral to Treatment Times Cardiac Referral to Treatment Times Details of Return Referral to Treatment Times Referral to Treatment Times Details of Return Referral to Treatment Times (Combined) Referral to Treatment Times (Combined) Details of Return New / Retired / Changed Retired Retired Retired Retired New New Data Item Data Item Data Item Data Item Data Item Data Item Data Item Data Item Data Item Data Item Data Item Count Data Reference Local Sub Specialty Main Specialty (of Consultant) Organisation Code (Code of Provider) Organisation Code (LHB Area of Residence) Referring Organisation Code Return Date Stage of Pathway Treatment Function Code Weeks Wait Changed 12 Changed 12 Changed 14 Changed 15 Changed 16 Changed 17 Changed 18 Changed 19 New 20 Changed 21 Changed 23 Term Term Diagnostic Intervention Therapeutic Intervention New New Appendix Appendix Appendix A Specialty Codes For General Use (Numerical) Local Sub Specialty Codes Appendix A Specialty Codes For General Use (Numerical) Other Changed 28 Changed 28 7 of 29

8 Appendix B: Highlighted changes to be made Dictionary to the NHS Wales Data Changes to the NHS Wales Data Dictionary are detailed below, with new text being highlighted in blue and deletions are shown with a strikethrough. The text shaded in grey shows existing text copied from the NHS Wales Data Dictionary. Changes to Aggregate Data Sets Cardiac Referral to Treatment Times (Retired) : April 2009 : 3 August This return was discontinued following its merger with the Referral To Treatment (RTT) Times and the addition of Diagnostic & Therapy Waiting Times and Stage of Pathway details to form the Referral to Treatment Times (Combined) return, effectivee from October. Cardiac Referral to Treatment Times - Details of Return (Retired) See Referral to Treatment Times (Combined) Cardiac Referral to Treatment Times (Retired) Details of Return Field Order Data Reference Return Date Organisation Code (LHB Area of Residence) Organisation Code (Code of Provider) Referring Organisation Code Weeks Wait Count Format 2 alpha characters ccyymmdd 3 alpha numeric characters 3 alpha numeric characters 3 alpha-numeric characters Alpha Numeric Numeric * If the count is zero for a month wait time band, a row for that week s wait s dataa need not be submitted. The number of patients waiting each number of weeks is entered in the count field. The Business Service Centres will provide data sets to Health Statistics & Analysis Unit, WAG by the last working day of the month after the reporting period. To enable the BSC to meet this timetable, Local Health Boards /Trusts should submit data to the BSC local office no later than 20 days after the end of the reporting period. Return Details for Local Health Boards/ Trusts: 8 of 29

9 All files should be sent in the form of a comma separated text file (csv format) to the BSC by the 20th day of the month and ed to: Files should be named as: CRTTxxxmmmyy.csv Where: xxx = the Local Health Board/ Trust Code mmm = first threee letters of the month to which the data relates yy = last two digits of the year Return Details for the Business Service Centres: All files should be sent in the form of a comma separated text file (csv format) to HSA by the 25th day of the month and ed to: stats.health@wales. gsi.gov.uk Files should be names as: CRTTxxmmyy.csv Where: xx = the last two numbers of the BSC code mmm = first threee letters of the month to which the data relates yy = last two digits of the year Referral to Treatment Times (Retired) : April 2007 : 3 August This return was discontinued following its merger with the Referral To Treatment (RTT) Times and the addition of Diagnostic & Therapy Waiting Times and Stage of Pathway details to form the Referral to Treatment Times (Combined) return, effectivee from October. Referral to Treatment Times -Details of Return (Retired) See Referral to Treatment Times (Combined) Referral to Treatment Times Details of Return (Retired) Field Order Data Reference Return Date Organisation Code (LHB Area of Residence) Organisation Code (Code of Provider) Main Specialty (Consultant) Weeks Wait Count Format 2 alphaa characters ccyymmdd 3 alpha numeric characters 3 alpha numeric characters 3 digit numeric Alpha Numeric Numeric All returns are to be sent in the form of a comma separated text file (csv format), i.e. in which the values in each field are separated by commas. There will be no header record. The return should be named as: xxxmmmyy.csv 9 of 29

10 where: xxx = the Local Health Board/ Trust code mmm = first threee letters of the month to which the data relates, e.g. Apr for the first submission of dataa relating to waiting times at end April. yy = last 2 digits of the year The return should be sent via the secure upload mechanism located on uk/ Each time a return is submitted, Local Health Boards /Trusts should complete a HSW submission form and send it via to Waitingtimes@wales.nhs.uk with a subject heading of 'Referral to Treatment Times'. Returns should be sent to reach HSW on the 25th day of the month or the next working day. From April 2008, the inclusion of the Local Health Board is mandated. Only include RTT waits for elective specialty services available in your Local Health Board/ Trust. If your Local Health Board/ Trust provides a service but there are no patient s with neither open or stop clocks, a zero should be placed in the zero week wait time band and the LHB field should be left blank. Referral to Treatment Times (Combined) : 1st See Referral to Treatment Times (Combined) Details of Return Referral to Treatment Times (Combined) Details of Return Field Order Data Reference Return Date Organisation Code (LHB Area of Residence) Organisation Code (Code of Provider) Referring Organisation Code Treatment Function Code Local Sub Specialty Code Stage of Pathway Weeks Wait Count Format 2 alpha characters ccyymmdd 3 alpha numeric characters 3 alpha numeric characters 3 alpha-numeric characters 3 digit numeric 3 digit numeric 1 digit numeric Alpha Numeric Numeric All returns are to be sent in the form of a comma separated text file (csv format). There will be no header record. The return should be named as: 10 of 29

11 xxxmmmyy.csv where: xxx = the Local Health Board / Trust code. mmm = first threee letters of the month to which the data relates, e.g. Apr for the submission of data relating to waiting times at end April. yy = last 2 digits of the year. Each file may contain RTT data relating to one month only i.e. containn data relating to one return (or census) date only. Resubmissions are routinely permissible for the month proceeding the current reporting month only and should be submitted separately. The return should be sent via the secure upload mechanism located on the NHS Wales Data Switching Service (NWDSS) Returns should be submitted monthly and signed off in the NHS Wales Data Switching Service by Local Health Boards / Trustss by 17:00 on the 10 th working day of the month. The 26 week Referral to Treatment Time target is applicable to Welsh residents only. Therefore, there is no requirement to submit Referral to Treatment Times for English patients being treated (or waiting for treatment) in Welsh LHBs. Where LHBs / Trusts provide specialty services for which there are no waits to report, they are not required to include a count for that specialty. However, if the Local Health Board / Trust provides a zero open or closed pathway count for any specialty, the Organisation Code (Code of Provider) ), Treatment Function Code and Local Sub Specialty Code fields should be populated as normal and: - CP or OP may be submitted in the Data Reference field, depending on the data reference where the zero count is applicable; - X98 should be submitted in the Organisation Code (LHB of Residence) field; - X98 should be submitted in the Referring Organisation n Code field; - A 9 should be submitted in the Stage of Pathway field; - A zero should be submitted in the zero Weeks Wait time band; - A zero should be submitted in the Count field. For Welsh residents treated (or waiting for treatment) in England: NWIS is routinely provided with data for Welsh residents being treated (or waiting for treatment) in England. This data is initially supplied monthly by a number of English NHS organisations. NWIS is required to collate these individual returns into a single aggregate return and upload via the NHS Wales Data Switching Servicee NWIS will provide monthly data extracts of Welsh residents treated (or waiting for treatment) in English NHS organisationss to each LHB / Trust. LHBs / Trusts are required to validate their data and agree their data to be reported centrally with NWIS by the 8 th working day of the each month. NWIS is then required to submit a single all-wales return monthly, which should be signed off in the NHS Wales Data Switching Service by 17:00 on the 10 th working day of each month. Each monthly return should relate to data for the reporting period one month previous to the current reporting month e. g. in June, data for Welsh residents treated (or waiting for treatment) in England in April should be submitted. 11 of 29

12 Changes to Data Items Count This data item is / was included in the following data sets / collections between the dates shown: Data Set / Collection DT Waiting Times RTT PP01W RTT-PTR CRTT Angiogram RTT (Combined) 2009 April 2007 April st December st 3 3 t August 30 th 2009 t August April 2010 This is the numeric field showing number of patients in each time band. For DT, /RTT (Combined) and / PP01W, ssee Weeks Wait For RTT-PTR See Time Band Relating to Breach Date Data Reference This data item is / was included in the following data sets / collections between the dates shown: Data Set / Collection DT Waiting Times RTT PP01W RTT-PTR CRTT Angiogram RTT (Combined) 2008 April 2007 April 2009 December st 3 3 t August 30 th 2009 t August April 2010 This defines the record type within a return. Must be one of the following: 12 of 29

13 For Diagnostic and Therapy Services Waiting Times: - Format: 2 character alpha Value Return Type IE Inpatient Diagnostic Endoscopy DE Day Case Diagnostic Endoscopy OE Outpatient Diagnostic Endoscopy DT For all other specified Diagnostic and Therapy Services For Referral to Treatment Times (Retired): - Format: 2 character alpha Value PO CA Return Type Open Pathway Closed Pathway Due to Admission Valid From April 2007 April 2007 CO Closed Pathway Due to Other Clock Stop April 2007 Point 3 August 3 August 3 August For PP01W:- Format: 2 character alpha Value Return Type IP Inpatient Admission DC Day Case Admission OP First Outpatientt Appointment Valid From For Referral to Treatment Patient Tracking Report (Retired):- Format: 2 character alpha Value Return Type BU Patients on RTTT pathways for whom a decision to admit or to commence treatment has not been made (i.e. Unknown) BD Patients on RTTT pathways for whom a decision for treatment has been made but have an appointment date which is scheduled beyond their breach date th th 2009 For Cardiac Referral to Treatment Times (Retired):- Format: 2 character alpha Value Return Type OP Open Pathway April August 13 of 29

14 CP Closed Pathway April August For Referral to Treatment Times (Combined):- Format: 2 character alpha Value Return Type OP Open Pathway CP Closed Pathway 1st 1st For Angiogram (Retired):- Format: 2 character alpha Value Return Type IA Inpatient Admission DA Day Case Admission December 2008 December 2008 April 2010 April 2010 Local Sub Specialty This data item is / was included in the following data sets / collections between the dates shown: Data Set / Collection APC ds99 EAL ds OP ds PP01W RTT (Combined) 1st This is a locally or nationally defined division of clinical work which may cross specialty boundaries. Format: 3 character alpha-numeric Treatment Function Code Local Sub Specialty Code NNN Any 000 No appropriate sub-specialty 666 Assessment Unit May 1998 April of 29

15 160 Plastic Surgery 170 Cardiothoracic Surgery 320 Cardiology 400 Neurology 100 Plastic Surgery (non burns) 166 Plastic Surgery (non burns) ASSESSMENT 200 Burns Surgery 266 Burns Surgery ASSESSMENT 100 Cardiac Surgery 166 Cardiac Surgery ASSESSMENT 200 Thoracic Surgery 266 Thoracic Surgery ASSESSMENT 300 Paediatric Cardiac Surgery 366 Paediatric Cardiac Surgery ASSESSMENT 100 Paediatric Cardiology 166 Paediatric Cardiology ASSESSMENT 100 Spinal Injuries 166 Spinal Injuries ASSESSMENT 900 Other Neurology 966 Other Neurology ASSESSMENT May 1998 April 2009 May 1998 April 2009 May 1998 April 2009 May 1998 April 2009 May 1998 April 2009 May 1998 April 2009 May 1998 April 2009 May 1998 April 2009 This local sub specialty code is a separate field, rather than an extension. For Referral to Treatment Times (Combined):- - - Local Sub Specialty must always be submitted, noting that 000 means no appropriate Local Sub Specialty; Codes for Assessment activity (i.e. 666, 166, 266, 366 and 966) are not permissiblee in the RTT (Combined) return. Main Specialty (consultant) (This data item was formerly known as Specialty Function Code with the new title being implemented from 15 th May 2006) This data item is / was included in the following data sets / collections between the dates shown: Data Set / Collection APC ds99 EAL ds OP ds RTT PP01W OPR ds RTT-PTR April 2007 July t August 30 th 2009 This is the main specialty of the Consultant. It is a unique identifier for a specialty function. A specialty function is a division of clinical work to a lower level than that designated by Royal Colleges and Facilities. 15 of 29

16 Format: 3 digit numeric See Appendix A Organisation Code (Code of Provider) This data item is / was included in the following data sets / collections between the dates shown: Data Set / Collection APC ds99 EAL ds OP ds CC ds OPR ds DATS RTT RTT-PTR PP01W EDDS RTT (Combined) 2008 April 2007 July 2008 April 2007 April st Valid To 3 August 30 th 2009 This is the organisation code of the health care provider. The provider code identifies the health care provider who is responsible for managing the treatment of the patient. Notes: 1. Healthcare providers may also act as commissioners when sub-contracting patient care services to other providers of health care. 2. Although the healthcare provider identified in this data item is responsible for managing the patient s treatment, it may not necessarily be where the treatment is actually conducted. For example, where the treatment has been sub-contracted to another healthcare provider. 3. For OPR ds, the Organisation Code (Code of Provider) is that of the organisation receiving the referral. If the provider is a Local Health Board/Trust, use the 3 character Local Health Board/Trust code with 2 zeros placed in the 4th and 5th character position. 4. For Referral to Treatment Times (Combined), use the 3 character Local Health Board/Trust code. Format: For Patient Level Data Sets (APC, EAL, OP, CC, OPR):- 5 character alpha-numeric position. Local Health Board/Trust Code with 2 zeros placed in the 4 th and 5 th character 16 of 29

17 For Aggregate Data Collections (DATS, RTT (Combined) and, RTT-PTR, PP01W):- 3 character alpha numeric Local Health Board/Trust Code Value XAABB Meaning The organisation code for the provider Default codes: Value Meaning Non-Uwhere no provider organisation code has been issued Non-NHprovider where UK no organisationn code has been requested and issued April 2004 April 2002 See ORGANISATION CODE Organisation Code (LHB Area of Residence) This data item is / was included in the following data sets / collections between the dates shown: Data Set / Collection APC ds99 EAL ds OP ds RTT PP01W OPR ds EDDS CRTT Angiogram RTT (Combined) April 2007 July 2008 June st December st 3 3 t August t August April of 29

18 The Local Health Board where the patient is a resident, identified via the NHS Postcode Directory. This ensures that the Local Health Board can receive information about the care given to its residents. Format: 3 character alpha-numeric Value Meaning NAN The code of the LHB. Codes for Welsh LHBs are listed in Appendix C [3(A)]. X98 Not applicable e.g. for overseas visitors N/A April 1996 N/A Note: For English Residents treated in Wales, use the Organisation Code of the Primary Care Trust (PCT) of Residence. Referring Organisation Code This data item is / was included in the following data sets / collections between the dates shown: Data Set / Collection APC ds99 EAL ds OP ds OPR ds EDDS CRTT RTT (Combined) July 2008 April 2009 April st Valid To 3 August The code of the organisation of the General Medical Practitioner (GMP), General Dental Practitioner (GDP) and Consultant or Independent Nurse making the referral. This information is essential for managing contracts which are based on patterns of referral. Where a five character Organisation Code is used, it should be left justified and padded with a space. Default codes: Format: 6 character alpha-numeric Value Meaning X99998 Organisation code not applicable X99999 Organisation code not known May 1998 May th January of 29

19 For Referral to Treatment Times (Combined):- For the RTT (Combined) return, this data item should only be used to capture the 3 character Organisation Code (Code of Provider) when a tertiary referral takes place from one secondary care organisation to another for Cardiac patients only i.e. Treatment Functionn Code 170 (Cardiothoracic Surgery) or 320 (Cardiology). In all other cases, X98 should be submitted. The receiving organisation is responsible for submitting RTTT (Combined) data for any Cardiac tertiary referrals they have received from another organisation. See ORGANISATION CODE Note: Emergency patients referred via NHS Direct will require the data item Method of Admission to have the value 27 ('Via NHS Direct Services'). Return Date This data item is / was included in the following data sets / collections between the dates shown: Data Set / Collection DT Waiting Times RTT PP01W RTT-PTR CRTT Angiograms RTT (Combined) April st December st 31 st August April st August t April This relates to the date on which the list is measured, that is, last day of the month to whichh the return relates. This is also known as the census date. Format: 8 numeric digits in the format: - cccyymmdd 19 of 29

20 Stage of Pathway This data item is / was included in the following data sets / collections between the dates shown: Along an entire patient pathway, Stage of Pathway is used to identify the point at which a patient is currently waiting in respect of their overall diagnosis and treatment. Whilst in the majority of patient pathways patients move from one stage to the next in sequence, there is no expectation that this must always be the case. Changes in clinical practice may introduce more variation over time. Therefore, these stages are not intended to be seen in chronological order only, as patients may commence their pathway at any one of the stages listed below. Format: 1 digit numeric Stage of the Pathway Stage of the Pathway Waiting for a new outpatient appointment. A new Outpatient Appointment may come from any referral source. A patient will be at Stage 1 only once. Waiting for a diagnostic or Allied Health Professional (AHP) test, intervention or result. For relevant diagnostic and AHP services, see Treatment Function Code. Waiting for a follow-up outpatient appointment or waiting for a decision following: 1) An outpatient appointment. 2) A diagnostic or AHP intervention result. 3) Or where the patient is waiting and the stage is uncertain/unknown. Waiting for an admitted diagnostic or therapeutic intervention (i.e. treatment) only. Not applicable e.g. closed pathway. See Diagnostic Intervention See Therapeutic Interventionn See Treatment Function Code 20 of 29

21 Treatment Function Code This data item is / was included in the following data sets / collections between the dates shown: Data Set / Collection APC ds99 OP ds EAL ds CC ds OPR ds RTT (Combined) April 2007 July st (This data item was formerly known as Consultant Specialty Function Code with the new title being implemented from 15 th May 2006) This is the specialty under which the patient is treated. This may either be the same as the specialty function recorded as the consultant's main specialty or a different specialty functionn which will be the consultant'ss interest specialty function. Note that both the main specialty functionn and the interest specialty function should be based on one of the Royal College specialties. Notes - - : For the Outpatient Referrals Data Set this is the specialty under which the patient is intended to be treated. For Referral to Treatment Times (RTT) (Combined): Diagnostic Services o o For pre-consultant referrals to a diagnostic service specified in the table below, a pseudo Treatment Function Code of 998 (Diagnostic Services) should be used. Following a consultant referral, the wait for a patient referred to any diagnostic service should be captured using the Treatment Function Code of the referring specialty. Allied Health Professional (AHP) Services o o For pre-consultant referrals to an Allied Health Professional (AHP) service specified in the table below, a pseudo Treatment Function Codes of 999 (Allied Health Professional Services) should be used. Following a consultant referral: Should clinical responsibility remain with the referring consultant, the Treatment Function Code should be that of the referring specialty. 21 of 29

22 Should clinical responsibility for patientt care transfer to an AHP service specified in the table below a Treatment Function Code of should be used. Consultant Referrals o o For consultant referrals, a pseudo Treatment Function Code should not be used. As per current RTT rules, the Treatment Function Codes above are not to be used for the reporting of Mental Health and Learning Disabilities Referral to Treatment Times. Diagnostic & Allied Health Professional (AHP) Services Service Audiology (Adult Hearing Aids) Cardiology Diagnostic Endoscopy Dietetics Imaging Neurophysiologyy Occupational Therapy Physiological measurement Physiotherapy Podiatry Radiology GP Referral Radiology Consultant Referral Speech & Language Service Sub Heading Consultant GP Stress Test Echo Cardiogram Gastroscopy Flexible Sigmoidoscopy Colonoscopy Cystoscopy Bronchoscopy Adults Paediatrics Fluoroscopy Electromyography Nerve conduction studies Adults Paediatrics Urodynamic tests Vascular technology Adults Paediatrics Urgent Routine Barium Enema C.T. M.R. Non-Obstetric Ultrasound Nuclear Medicine Adults Paediatrics Diagnostic or Allied Health Professional (AHP) Service Diagnostic Service Diagnostic Service Diagnostic Service AHP Service Diagnostic Service AHP Service Diagnostic Service AHP Service AHP Service Diagnostic Service Diagnostic Service AHP Service Format: 3 digit numeric See Specialty/Specialty of Treatment Code 22 of 29

23 See Appendix A Weeks Wait This data item is / was included in the following data sets / collections between the dates shown: Data Set / Collection DT Waiting Times RTT PP01W CRTT Angiogram RTT (Combined) April 2007 April st December st 31 st August 31 st August t April The time bands for reporting the waiting time counts, some values of which vary between returns developed for different purposes. The principle for recording the time band for a weeks wait is shown below: - For reporting purposes a weeks wait is a value of x and refers to "Over x weeks and up to x+1 weeks". The calculation from days to weeks wait reported is Integer value of (days-1)/7 or zero, whichever is greater. For example, to calculate the weeks wait for 277 days; use the calculation (days-1)/7: - (277-1)/7 = (equivalent to 39 weeks and 4 days). This will be recorded under the 'Over 39 weeks and up to 40 weeks (Day )' Time Band. The definition for 999 is different within the RTT (Combined) and PP01W collections. In the PPO1W it refers to suspensions and in RTT (Combined) it refers to patients with unknown RTT start clock date. The correct definition must be applied to the relevant return. Diagnostic and Therapy Waiting Times & PP01W: - The count of waiting time will start from the waiting list date and end on the census date, which is the last day of each month. The waiting times will be reported grouped within time bands describedd in weeks up to 40 weeks wait. All waits beyond that will be reported in one group. Weeks Wait 0 1 Time Band Up to 1 week ( up to and including 7 days) Over 1 week and up to 2 weeks (day 8 to 23 of 29

24 2 Etc until ) Over 2 weeks and up to 3 weeks (day 15 to 21) Over 39 weeks and up to 40 weeks (day 274 to 280) Over 40 weeks (day 281 and over) Suspensions (for PP01W submissionss only) Referral to Treatment Times (Combined): - For open pathways, the length of referral to treatment time will be from the clock start date to the end of the census date, which is the last day of the month. For closed pathways, the length of referral to treatment time will be from the clock start date to the clock stop date, whichh is within the reporting period. The referral to treatment times will be reported grouped in time bands described in weeks up to 40 weeks. Over that, reporting will be in 4-week time bands up to a specified 105 weeks wait. Waits beyond that will be reported in one group. Where a Local Health Board/Trust is unable to identify a start clock dates for patients, these will be reported using a Weeks Wait value of '999'. Weeks Wait Etc until Etc up to Time Band Up to 1 week (up to and including 7 days) Over 1 week and up to 2 weeks (day 8 to 14) Over 2 weeks and up to 3 weeks (day 15 to 21) Over 39 weeks and up to 40 weeks (day 274 to 280) Over 40 weeks and up to 41 weeks (day 281 to 287) Over 41 weeks and up to 45 weeks (day 288 to 315) Over 45 weeks and up to 49 weeks (day 316 to 343) Over 49 weeks and up to 53 weeks (day 344 to 371) Over 101 weeks and up to 105 weeks (day 708 to day 735) Over 105 weeks (day 736 and over) Patientt with unknown RTT start clock date 24 of 29

25 See WHC (2006) 081 'Delivering a 26 week Patient Pathway' for definitions of 'waiting list date'. Cardiac Referral to Treatment Times (Retired):- Time waiting is the differencee in between the return date and the waiting list date. Weeks Wait Etc until Etc up to Time Band Up to 1 week (up to and ncluding 7 days) Over 1 week and up to 2 weeks (day 8 to 14) Over 2 weeks and up to 3 weeks (day 15 to 21) Over 39 weeks and up to 40 weeks (day 274 to 280) Over 40 weeks and up to 41 weeks (day 281 to 287) Over 41 weeks and up to 45 weeks (day 288 to 315) Over 45 weeks and up to 49 weeks (day 316 to 343) Over 49 weeks and up to 53 weeks (day 344 to 371) Over 101 weeks and up to 105 weeks (day 708 to day 735) Over 105 weeks (day 736 and over) Patient with unknown RTTT start clock date For open pathways, the length of the pathway is measured from the date of referral to the date of the return date (end of the month). An open pathway is recorded where a patient falls within the scope of the target who has not yet reached a stop clock point at the end of the month. For closed pathways, the length of the pathway is measured from the date of referral to the date of the stop clock point. A closed pathway is recorded where a patient who falls within the scope of the target has reached a stop clock point within the month. Angiogram (Retired) - The count of waiting time is the difference in weeks between the return date and the date of decision to admit, not counting periods of suspension. Refer to the current rules regarding management of suspensions. The waiting times will be reported grouped within time bands describedd in weeks up to 26 weeks wait. All waits beyond that will be reported in one group. Weeks Wait Time Band 25 of 29

26 0 1 2 Etc until 26 Up to 1 week (up to and including 7 days) Over 1 week and up to 2 weeks (day 8 to 14) Over 2 weeks and up to 3 weeks (day 15 to 21) Over 26 weeks (day 183 and over) 26 of 29

27 Changes to Terms Diagnostic Intervention A clinical intervention intended to diagnose a patient s disease, condition or injury. Therapeutic Intervention A clinical intervention intended to manage a patient s disease, conditionn or injury and avoid further clinical interventions. 27 of 29

28 Changes to Appendices Appendix A Specialty Codes For General Use (Numerical) Local Sub-Specialty codes To cover the previously used 4-digit codes, a LOCAL SUB-SPECIALTY CODE has been introduced and is a separate field, rather than an extension. This is a locally defined division of clinical work which may cross specialty boundaries. Please note that where theree is no appropriate agreed local sub specialty code, the digits 0000 should be used. Where the code is used to record data under the heading Paediatric Cardiology, this information should NOT be included in data recorded under the heading Cardiology (code ). For NHS Wales, the agreed sub divisions of Specialty are: Treatment Function Code Local Sub Specialty Code NNN Any 000 No appropriate sub-specialty 666 Assessment Unit May 1998 April Plastic Surgery 100 Plastic Surgery (non burns) 166 Plastic Surgery (non burns) ASSESSMENT 200 Burns Surgery 266 Burns Surgery ASSESSMENT May 1998 April 2009 May 1998 April Cardiothoracic Surgery 100 Cardiac Surgery 166 Cardiac Surgery ASSESSMENT 200 Thoracic Surgery 266 Thoracic Surgery ASSESSMENT 300 Paediatric Cardiac Surgery 366 Paediatric Cardiac Surgery ASSESSMENT May 1998 April 2009 May 1998 April 2009 May 1998 April Cardiology 100 Paediatric Cardiology 166 Paediatric Cardiology ASSESSMENT May 1998 April Neurology 100 Spinal Injuries 166 Spinal Injuries ASSESSMENT 900 Other Neurology 966 Other Neurology ASSESSMENT May 1998 April 2009 May 1998 April 2009 Appendix A Other Specialty Codes For General Use (Numerical) Community Medicinee Occupational Medicine 28 of 29

29 Nursing Joint Consultant Clinics Diagnostic Services* Alllied Health Professional (AHP) Services* Notes: * 998 and 999 are not Treatment Function Codes. They are pseudo Treatment Function Codes and are only to be used for the reporting of RTT (Combined) dataa for diagnostic and Allied Health Professional (AHP) services. See Treatment Function Code 29 of 29